ECT vs rTMS: New Register Study From Sweden

Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode: A Register-Based Study.

Strandberg P, Nordenskjöld A, Bodén R, Ekman CJ, Lundberg J, Popiolek K.J ECT. 2023 Nov 30. doi: 10.1097/YCT.0000000000000971. Online ahead of print.PMID: 38048154


The abstract is copied below:


Objectives: Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in treating depression. Although rTMS induces fewer adverse effects, its effectiveness relative to ECT is not well established. The aim of this study was to investigate the treatment outcomes of ECT and rTMS in patients who have received both interventions.

Methods: This was a register-based observational crossover study in patients with depression who had undergone ECT and rTMS in Sweden between 2012 and 2021. Primary outcome was reduction in the Montgomery-Åsberg Depression Rating Scale-Self-report (MADRS-S) score. Secondary outcome was response defined as a 50% or greater decrease in the MADRS-S score. Subgroup analyses were performed to identify factors that predicted differential responses between rTMS and ECT. Continuous and categorical variables were analyzed using paired-samples t tests and McNemar tests, respectively.

Results: In total, 138 patients across 19 hospitals were included. The MADRS-S score after ECT and rTMS was reduced by 15.0 and 5.6 (P = 0.0001) points, respectively. Response rates to ECT and rTMS were 38% and 15% (P = 0.0001), respectively. Electroconvulsive therapy was superior across all subgroups classified according to age and severity of depression.

Conclusions: Our results suggest that ECT is more effective than rTMS in treating depression among patients who have received both interventions. Age and baseline depression severity did not predict who would similarly benefit from rTMS and ECT.

The article is here.
And from the text:





Here is another very interesting study from Swedish registry data, published in JECT.
These effectiveness data, while not surprising at all, are very useful additions to the literature. Complex methodological issues and study design limitations notwithstanding, it is an innovative concept to have looked at patients who got both ECT and rTMS.
It is likely that the field will come to the conclusion that ECT and rTMS are for quite different patient populations.
Kudos to Axel Nordenskjöld and Swedish colleagues for this thoughtful, and well-presented, study.


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